Tag Archives: preterm birth

NICE Diagnostics consultation: Biomarker tests to help diagnose preterm labour in women with intact membranes

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The National Institute for Health and Care Excellence (NICE) is producing guidance on using biomarker tests (Actim Partus, PartoSure and the Rapid fFN 10Q Cassette Kit) in the NHS in England. The diagnostics advisory committee has considered the evidence base and the views of clinical and patient experts.

The advisory committee is interested in receiving comments on the following:

  • Has all of the relevant evidence been taken into account?
  • Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?
  • Are the provisional recommendations sound, and a suitable basis for guidance to the NHS?

The consultation will close on 3rd April.  More details available from NICE here

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NIHR Signal: Delayed umbilical cord clamping reduces hospital mortality for preterm infants

Preterm baby - pixabay
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Delays to clamping the umbilical cord of about a minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood transfusion by 10%.

This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit.

These findings are consistent with current guidelines which recommend delayed clamping in preterm infants.

“Cheap, quick and effective interventions in medicine are rare, but delayed clamping of the umbilical cord at birth appears to be just that.

A systematic review of 18 trials including almost 3,000 preterm babies confirms that delaying cord clamping by 60 seconds reduces mortality before hospital discharge. It also makes it less likely that babies will need blood transfusions, and there is no apparent increase in morbidity for mother or baby.

On a worldwide scale, given the large number of babies born before 37 weeks of gestation, the potential benefits of waiting patiently for just one minute are huge.”

Dr Elaine Boyle, Associate Professor in Neonatal Medicine, University of Leicester; Honorary Consultant Neonatologist, University Hospitals of Leicester NHS Trust

Read the full signal here

 

 

NIHR Signal: Caesarean section is better for extremely premature breech babies but not necessarily for their mothers

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Delivering extremely preterm breech babies (23 to 27 weeks) by caesarean reduced the risk of infant death or brain bleeds by around 40% compared with vaginal delivery.

Choice of delivery is a balance of risks for mother and baby. There are immediate risks to the mother associated with anaesthesia and surgery but also risks in subsequent pregnancies following surgery on the immature uterus. In this review, there was limited information on outcomes for the mothers.

NICE recommend that the mother is informed of the potential harms and benefits of all options. The harms to the mother remain unclear, which is an important gap in knowledge.

“This publication (admittedly flawed) suggests a protective effect of CS for these babies. Our counselling should now acknowledge that CS is probably in the interests of the baby (if we are sure birth will occur soon), but not of the woman.”

Rhona Hughes, Clinical Director for Obstetrics & Neonatology, NHS Lothian

Read the full signal here

 

BJOG: Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study

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The objective of this study was to investigate whether advanced maternal age is associated with preterm birth, irrespective of parity.
The study concluded that advanced maternal age is associated with an increased risk of preterm birth, irrespective of parity, especially very preterm birth. Women aged 35 years and older, expecting their first, second, or third births, should be regarded as a risk group for very preterm birth.

Waldenström U, Cnattingius S, Vixner L, Norman M. Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study. BJOG 2017; 124:1235–1244.

For details of full text click here 

NIHR signals: A dose of corticosteroids benefit most women anticipating a preterm delivery

Preterm baby - pixabay
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Giving corticosteroids to most women who are anticipating labour before completing 37 weeks of pregnancy helps reduce immediate health problems in the baby compared with placebo or no intervention. Deaths around the time of birth were reduced by 28% and babies were a third (34%) less likely to develop respiratory distress syndrome.

A corticosteroid dose is already used for women who go into labour or if waters break before 37 weeks or where delivery is planned for other reasons. The drug accelerates the development of the baby’s lungs and reduces breathing difficulties at birth. This recommendation followed decades of research.

This review supports current practice of using a dose of corticosteroids in high-income settings and was designed to include more recent research and to look in more depth at new questions, such as the risk of infection. Evidence is still lacking in low-income settings and some very high-risk groups, like twins. There is also remaining uncertainty about the best corticosteroid, its dose and timing.

Read the full signal here